Program Operations Manual System (POMS)
TN 4 (05-19)
DI 39545.525 Exhibit 1 – Suggested Protocol for DDS Onsite Reviews of Consultative Examination
(CE) Providers
Date _________________
-
A.
Name and address of facility/provider
-
-
C.
Types of examinations conducted
-
D.
Provider has performed consultative examinations (CEs) for DDS since
-
E.
Provider contact name and phone number
-
F.
Provider classification
Key provider or top five CE provider by dollar volume
Yes_______ No________
-
-
H.
Facilities
-
1.
Building
-
-
-
c.
Safe location for claimants to travel
-
-
e.
Public Transportation and Parking
-
-
-
h.
Secure location for medical records and computer records
-
2.
Equipment/Laboratory Tests
-
-
-
I.
Staff
-
-
-
-
4.
Does medical source speak any language other than English?
If so, which language?
-
J.
Scheduling
-
1.
What is maximum number of CEs scheduled per medical source per day per specialty?
-
2.
What are minimum interval times that the CE provider schedules for an exam?
-
3.
What is actual length of time for exams to be completed per visit?
-
K.
Procedures
-
1.
Privacy and confidentiality of claimant information
-
2.
How and from who is the claimant’s medical/psychological history obtained?
-
3.
How much time does the medical source spend face-to-face with the claimant?
-
4.
Does the source certify that assistants meet the appropriate licensing or certification
requirements of the State?
-
L.
Laboratories
-
1.
Diagnostic and lab tests: Performed by (if by a non-physician, state performer’s qualifications)
-
2.
Interpreted by (if by a non-physician, state the interpreter’s qualifications).
-
3.
Turnaround timeliness, including both the results of the tests and interpretations.
-
M.
Exit Interviews of Claimants
-
N.
Does provider transmit CE report electronically? If so, fax, website, C:D, etc.
References:
-
•
PM 00233.005 Regional Office (RO) Consultative Examination (CE) Oversight Procedures
-
•
PM 00233.900 Regional Office (RO) Guide for Evaluating Disability Determination Service
(DDS) Management of the Consultative Examination (CE) Process
To Link to this section - Use this URL: http://policy.ssa.gov/poms.nsf/lnx/0439545525
| DI 39545.525 - Exhibit 1 – Suggested Protocol for DDS Onsite Reviews of Consultative Examination (CE) Providers - 09/21/2007
Batch run: 05/10/2019
Rev:09/21/2007 |